Medication exchange systems, wherein a health care provider such as a long term care center or the like periodically receives prefilled medication dispensing containers in exchange for previously utilized similar containers, have been advantageously utilized in various forms. For example, as illustrated in U.S. Pat. No. 4,384,649, which issued to L. Brodsky, unit doses of medication individually sealed within disposable blister-type packs have been contained within reuseable plastic dispensers, wherein medication can be dispensed from the blister pack using finger-strength pressure. In this two-piece dispensing package, the blister pack and its cover is held within a hinged outer shell, whereupon closing of the outer shell forces a cutting edge thereof into contact with the blister pack cover, thereby forming a seal around each blister pack pocket. Dispensing devices similar to those described in the Brodsky patent have been available in the industry, such as from Wayne-Ferrell, of Smithtown, N.Y. These devices have been marketed under the name "dispens-A-dose" for use in conjunction with interchangeable drawers or cassettes in medication delivery carts and the like.
Other exchangeable unit does systems have also been available in the industry, such as illustrated in U.S. Pat. Nos. 4,084,695 and 4,253,572, which issued to F. Halbich, and U.S. Pat. No. 4,372,445, which issued to P. Keffeler. These patents generally describe plastic pill box designs which receive a plurality of unit dose tablets or the like. The pill box is sealed by a clear plastic cover having a plurality of frangible portions which enable individual compartments of the pill box to be separately opened for dispensing operations. The cover can be provided of a relatively clear or transparent material to provide visual access to the medication compartments. Similar box and frangible lid structures have been available in the industry, such as from Omni Medical Systems, Inc., of Marion, Iowa, (sold under the names "Omni 1"and "Omni 8"), and from Opus Unit Dose Systems, of Omaha, Nebr. These unit dose systems have also been marketed in conjunction with plastic dispensers which can be utilized in conjunction with medication carts.
Still other exchangeable systems have also been known, such as described in U.S. Pat. No. 3,826,222, which issued to J. Romick. This unit-dose medication handling system comprises a medication tray having a plurality of dividers for defining compartments for receiving unit-dose dispensing boxes. The dispensing boxes are generally made of cardboard and are adapted to receive a plurality of unit-dose packs of medication. The unit doses may be in the form of separate viles, capsules, envelopes, or strip packs. A pressure sensitive label is adhered to the box for identification. A tray can be utilized for a single patient, wherein a plurality of prescription boxes can be placed in the adjacent compartments, with the pharmacist filling each box with a predetermined number of unit doses. The tray can also be disposed on a shelf of a mobile medication cart for use in dispensing procedures. While systems similar to the structure described in the `222 patent have been available, the cardboard dispensing boxes tend to be only marginally reusable, of only limited effectiveness for security of individual doses (vis-a-vis pilferage), cumbersome, and provide poor visual accountability of medication.
Other forms of reuseable medication dispensing devices have also been available in the industry. For example, blister-type medication cards have been available with reuseable punch frames, such as marketed by Artromick of Columbus, Ohio under the names "TimePak-7" and "PunchPak". These devices include reuseable punch frames similar to that described with regard to U.S. Pat. No. 4,384,649 above, and are used in conjunction with blister-type packages inserted therein. These frames can also be used with and stored loosely within medication cart drawers or the like.
While there have been a variety of exchangeable unit dosing systems, such as described above, each have their own shortcomings, some of which have been detailed above. Generally, heretofore, there has not been available a single system which combines the advantages of disposable punch card packages having excellent visual accountability, high integrity seals, and low cost packaging per dose, with the benefits of exchange systems which minimize inventory and reordering requirements, minimize packaging and product waste, and increase medication security. The exchangeable systems described above, while offering some of these advantages, could not offer all of the advantages in a single, relatively simple, and substantially modular format.
Moreover, most of the exchangeable systems previously available in the industry offered only a predetermined medication administration system, set up specifically for patient pass, time pass, or prescription pass only. In most cases, the same structure which provided for reuseability and exchange characteristics also imposed severe limitations on adaptability and applicability to the ever changing environment in modern health care facilities.